Técnica de la nefroscopia percutánea en posición supina / Technique of percutaneous nephroscopy in supine position

RESUMO

With our simplified technique of percutaneous kidney access it is possible to perform nephrostomies, nephrolithotomies, antegrade ureterolithotripsies, endopielothomies, percutaneous resection of pielocalicial tumors, antegrade ureteral repermeabilizations, etc. We accomplish the percutaneous kidney access under local anesthesia, that we complement with intravenous sedation in the nephroscopy cases. Patients are supine, with a 3 liters serum bag below the ipsilateral flank. We locate the cutaneous access point between the 12th rib and the iliac bone, one centimeter over of the place that supports the flank (it coincides with the posterior axilar line). The directio followed by the puncture needle is cranial oblique and rising. As a radiological guide, the mark of the calicial crushing the needle causes when it pushes the renal cortex in front of the selected calix, is usually enough. Only seldom it is necessary to rotata the radiological C arm. We consider that this form of kidney percutaneous access confers a great simplicity to this surgery, facilitating to the maximum is execution in daily practice. On the other hand, it avoids the urologist's hand irradiation, and reports a significant reduction of the surgical risk for the patient